[Reprinted from The Medical News, May n, 1895.] 
THE VALUE OF BIMANUAL SIMULTANEOUS 
EXAMINATION OF SYMMETRIC 
STRUCTURES. 
By LOUIS FAUGIlRES BISHOP, A.M., M.D., 
OF NEW YORK CI^Y-... 
The perfect man should be ambidextrous. The 
left hand should be able to perform, and with nicety, 
every motion that the right can perform. In medi- 
cal work there is a distinct advantage in being able 
to use both hands alike, and in having their sensi- 
bility and perception equally trained. This is not 
a difficult matter if the student recognizes its ad- 
vantage early in his career and makes all his exam- 
inations first with one hand and then with the other. 
It very often happens that a good deal of danger 
from infection is avoided by being able to avoid in 
an examination the use of a finger that has been 
scratched or injured. To the ambidextrous man 
this comes to be done almost without thought. 
Of course, there is no need of argument as to the 
value of bimanual examination in the usual sense— 
that is, with one hand upon one part of an organ 
and the other hand upon another part. There is 
another kind of bimanual examination that is of a 
good deal of value for quick and accurate diagnosis 
of surgical conditions. It depends upon the sym- 
metry of the body and upon a co-ordination of movements between the two hands of the examiner. 
How close this co-ordination is in performing sym- 
metric movements is best illustrated by taking a 
piece of chalk in each hand and drawing a symmetric 
figure, the right hand drawing the left half of the fig- 
ure, and the left hand the right half. A good system 
of examination of surgical conditions is as follows: 
Place the patient in a perfectly symmetric position, 
so that one-half of the body is as nearly as possible 
in the same relative position as the other half. 
Standing directly behind or in front of the patient, 
place one hand upon the part to be examined, and 
the other hand upon the corresponding healthy 
structure and palpate corresponding portions with 
each hand. For instance, in a case of suspected 
injury of the shoulder one stands directly behind 
the patient, and, starting with acromion processes, 
with the right hand upon the right shoulder and the 
left hand upon the left shoulder, each part of the 
healthy shoulder is palpated and compared with the 
corresponding part of the injured shoulder. By 
this means the sound part of the body is used as an 
anatomic model to refresh and furnish anatomic 
information at the instant when required; and the 
information so acquired has this advantage, that it 
is accurate for the patient in hand, and this cannot 
be true of any general description. It goes without 
saying that we must be on our guard not to be misled 
by the slight differences that exist between the right 
and left sides of all people, but in general the right 
and left sides of the same individual are more nearly 
alike than the right sides of two separate individuals. 
Manual skill in examinations of all kinds is 
worthy the immense amount of labor and patience that is necessary for its attainment. One should 
examine healthy structures every day and whenever 
the opportunity offers. For not only is attention 
required to attain skill in physical examination, but 
labor is necessary to maintain it when acquired. 
36 West Thirty-fifth Street.